Nor was B. ever seen by the Consultant at the teaching hospital which
promoted his care . That consultant thought he was held , after the first
contact , over such a long time ( 9years ) because he was considered suitable to
join in potential trials of new medications against depression . Drug companies
are keen to discover opportunities for 'trials' and often fund them .
Depression in alcoholic dependent people is not thought to be the same as that with
endogenous illness depression
His first referral to the mental health service which subsequently managed
his care , was in 1985 , when he was first seen at the Out-patient service by the
academic junior doctor . He noted the personal situation and the particular points of concern
, particularly a poor supporting response from his mother . She held the tenancy
. Subsequently his hinterland was not much noticed . At that time he was still
in work . A year later he lost that tie , when he was convicted of theft at
his place of employment .
After losing this job in 1986 , during his first contact with the mental health
services , and following an initial period of detoxification in a local mental
hospital , he kept Out-patient appointments with successive junior
medical staff , from whom he received different anti-depressant medications without substantial success . He was never the recipient of community nurse supervision , nor were the
Social Services ever taken with his case .
The Consultant in charge notes that the Social Service work with the
psychiatric service changed when that Department moved out . The previously
regular and accustomed meetings and presence , informal and formal , with
attached social workers , ceased in the mid 1980's following their structural reorganisation .
He was referred to a Housing Department , out of the concerns about his
home life , which arose during his Out-patient attendance . Letters were sent
giving psychiatric reasons for placing him on a priority for a flat of his own ,
but they were rejected by the Medical officer who reviewed applications for the
Housing department .
B. was never referred for social service help , neither from Out-Patient attendance nor when he was at the day centre , in the last year of support .
Contact with, and formal referrals to, the Social Services Department had
lapsed out of general usage . The Social Services Department
was concentrating upon service to the severe and enduring mental illness, and
B. did not achieve that status. His was a simple, medical based, out-patient led
care, and did not warrant the full Care Programme Approach . [ a general policy
in place since 1991 which asked for a needs assessment , a plan , a key worker
to see it through , and a review procedure for progress ]
That would have brought in to play a social worker input .
His 9-year contact with Out-Patient appointments, and the regular attendance during the final
year when he was at day care, was largely concerned with the drug treatment of
brief and recurrent depressions which never settled. One note to his GP
suggested a psycho-Geriatric service could be approached to see the mother
( probably after B. had described 'muddle' ) without any action being taken.
She came with B , when he attended at the Out patient Clinic at his own
request, late in 1993, in low spirits and according to his mother, who seemed
to take the lead at the interview, drinking heavily . He had not previously followed up an
invitation to be a day patient. It was after this visit that he went
regularly to the day centre where the Inquiry Report says that he was described as a star patient .
His six month spell at the day centre ended when he was found a training place. A fortnight into that placement he was discharged from any contact with the mental health services .
The discharge was instigated by the day
centre nursing staff, without any particular medical decision .
The day centre seems not to have had a regular psychiatrist, nor any social service input . Psychiatric medical junior staff were called in as trouble
was noted, rather than were part of an ongoing direction. At the same time he continued to
attend the Out-patient service.
Who was in charge ?
At the end of his day centre attendance, his key worker there reported his
feeling of devastation at the prospect of leaving. A junior doctor called in at
the time commented that under those circumstances, he should continue attending.
The discharge went ahead.
After the killing occurred, nobody from the psychiatric service saw him. Nor
did the Social Service Department, who saw him in custody, speak with the
psychiatric services. One doctor commented to the Inquiry that it might be a
breach of 'confidentiality' to approach the police for them to be involved. The doctor thought the patient's permission was required to release the medical
notes, even if there was some risk of self harm.
In the mental health services, they
knew he was in custody, to be charged with the responsibility for the tragedy .
In custody, awaiting his trial to account for killing his mother, he cut
his wrists on one occasion .
Whilst awaiting trial he made pathetic attempts to give himself some kind of
a future by securing the tenancy of the home dwelling, the tenancy of which lapsed
after his mother was killed. This was rejected , by the Housing Department .
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